The methadone clinic monopoly: Opioid treatment chains backed by private equity are fighting calls for reform

Private equity firms have acquired stakes in nearly one-third of all methadone clinics in recent years, gaining outsize control of the U.S. addiction treatment industry even as the country’s opioid epidemic has developed into a full-fledged public health crisis.

A small handful of little-known financial institutions now has an ownership stake in 562 methadone clinics across the country, according to a first-of-its-kind STAT analysis. And in the past two years, large clinic chains backed by private equity firms have launched a lobbying blitz aimed at preserving their exclusive right to dispense methadone, a powerful medication that cuts the risk of opioid overdose death by more than 50%.

Private equity’s surging interest in the methadone treatment industry adds a new layer to the fraught and fast-shifting debate over access to addiction medications. Currently, patients can obtain methadone only at a specialized clinic and usually must return each day to receive a single dose. But with opioids killing over 80,000 Americans each year, a widening array of voices — including lawmakers, patients, public health experts, and the American Medical Association — wants to create ways to bypass the clinic system.

The clinics are pushing back forcefully, citing potential unintended consequences and safety concerns about methadone, which is an opioid itself and can cause sedation or even overdose when misused. But those who favor expanded access see a different motivation: the bottom lines of corporate clinic chains and the private equity firms that back them.

“We have the physicians of America on our side, and they have the MBAs of America on their side,” Sen. Ed Markey (D-Mass.), an outspoken critic of methadone clinics and the co-author of a bipartisan bill that would allow trained addiction doctors to prescribe methadone directly to patients with opioid addiction, said in response to STAT’s findings. “They don’t want to surrender the profits that come from having a monopoly.”

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